F-23 | National in-hospital outcomes of catheter-directed interventions in patients with intermediate risk pulmonary embolism

Patients with intermediate risk pulmonary embolism (PE) are a vulnerable population prone to clinical deterioration. Treatment options include anticoagulation alone (AC), catheter-directed embolectomy (CDE), or catheter-directed thrombolysis (CDT). While clinical trials have shown hemodynamic improvements with catheter-based therapies, comparative outcomes of CDT versus CDE are limited. We queried the National Inpatient Sample (2016-2020) for adult patients with intermediate risk acute PE. Exclusion criteria included hemodynamic instability, ischemic stroke, limb ischemia, myocardial infarction, mechanical ventilation, systemic thrombolysis, and surgical embolectomy. The cohort was stratified as follows: CDT, CDE, or AC. Multivariable logistic and linear regression analyses were performed to characterize the association of each therapy with in-hospital outcomes, adjusting for Elixhauser comorbidities and potential confounders. Of the 15,580 patients identified with intermediate risk PE, roughly 50% were male and >70% were admitted to teaching hospitals. Compared to AC: CDT patients had lower intracranial hemorrhage (ICH), lower in-hospital mortality, and shorter length of stay, whereas CDE patients had higher non-ICH bleeding and comparable in-hospital mortality. Compared to CDE: CDT patients had lower non-ICH bleeding, less acute kidney injury, and shorter LOS (Table 1). Advanced therapies were associated with improved clinical outcomes over AC in the management of intermediate risk PE. There were differential outcomes observed between catheter-based treatment modalities.